Carpal Tunnel Syndrome usually effects the hand and often the forearm, though symptoms can radiate up into the shoulder. Symptoms involve tingling or burning sensations in the thumb and fingers, in particular the index and middle fingers and radial half of the ring finger. Symptoms arise due to compression of the median nerve which passes through the carpal bones of the wrist where there is a 'tunnel' and into the fingers. This can be due to a number of reasons not least repetitive movement or injury. The restriction of blood flow may also cause swelling in the hand and fingers.
To aid recovery, a wrist brace may be given to restrict movement, so reducing the swelling, steroids may be injected into the wrist area or as a last resort, surgery may be recommended.
CTS and TRIGGER POINT INVOLVEMENT
Scalene muscles referral pain pattern. Clair Davies, The Trigger Point Therapy Workbook, Ed.2
HOWEVER! - the problem could be coming from much further away. Trigger Points within the scalene muscles are capable of producing the same symptoms as CTS. The scalenes attach to the cervical vertebrae and to the first and second rib. If they have trigger points the muscles become shortened and can pull on the ribs which in turn will trap a multitude of nerves passing from the neck and shoulder down to the arm and hand. The first rib, when pulled too close to the clavicle, will squeeze the blood vessels and nerves that pass through this area on their way to and from the arm (known as the thoracic outlet, hence the diagnosis thoracic outlet syndrome is often given to these same symptoms). The impeded returning blood flow and disturbed nerve impulses may cause pain, swelling and numbness in the arm and hand. This swelling in the hand and wrist can compress the nerve in the carpal tunnel, which will then produce pain symptoms. Hence the diagnosis of Carpal Tunnel Syndrome may be misguided, and surgery ineffective, as this letter from an elderly patient shows, who came to me after surgery and physiotherapy yet continued to have restricted range of motion, stiffness and tingling.
I strongly advise that if you have been diagnosed with CTS or have similar symptoms you get your scalenes and all other contributing muscles to arm and hand pain checked out for trigger points. It really can be that simple!
Remember: There are many other muscles that can cause tingling and numbness in the arm and hand. The pectoralis major and minor and latissimus dorsi can cause pain down the lateral side of the arm and tingling into the hand, in particular the 4th and 5th fingers. Being so far removed from the hand it might seem unlikely but this is the trigger point pain pattern that a knowledgable therapist will know!